Dr. Pablo Stewart, a psychiatrist, testified about the care that California’s condemned prisoners receive, telling of a psychotic inmate who tried to kill himself three times — even punching pens through his eyes.

The man was kept on death row rather than hospitalized, Stewart said, because he signed an agreement to take his drugs and attend therapy sessions. A fourth suicide attempt soon succeeded.

“How is that good psychiatric care? After a person has three times tried to kill himself?” Stewart asked.

Lawyers for the state said the prisoner’s death was an isolated incident.

Lawyers for inmates want U.S. District Judge Lawrence Karlton to require psychiatric hospitalization for the most mentally ill prisoners on death row and to ban the use of pepper spray as a means of controlling the mentally infirm.

Attorneys for the state have not yet presented most of their defense. But they say in court briefs that Karlton is hearing of a handful of isolated incidents within a system that, overall, protects the mentally ill.

In those records, San Quentin’s chief of mental health and other state officials point to the creation of a 10-bed special care program at San Quentin this year as evidence that the state is providing adequate treatment.

The new program provides “continued and intensive mental health services to the most vulnerable patients …, forestalling the need for [a] higher level of care,” Dr. Eric Monthei, the mental health chief, said in one of the state’s court filings.

Stewart says the new unit is modeled after outpatient treatment programs and meant only to prevent less ill patients from worsening to the point that they need hospitalization.

In previous testimony, Karlton allowed prisoners’ lawyers to air three videotapes showing mentally ill prisoners being forced from their cells by guards using pepper spray, after the inmates refused to take medication or submit to psychiatric evaluation. The videos show screaming prisoners being drenched with the burning spray.

Lawyers for the state argued in their opening remarks that corrections officers use the minimum force necessary and that the prisoners on the tapes were not ultimately injured.

Karlton had ordered reporters in the courtroom to not use identifying information from the videotapes. But at the request of the Los Angeles Times, that edict was overturned Wednesday by the U.S. 9th Circuit Court of Appeals.

The ruling overcomes objections raised by lawyers for California's Department of Corrections and Rehabilitation, who said the tapes contain private information.

“We are gratified that the 9th Circuit acted so quickly to reverse this unconstitutional prior restraint on the media,” said Kelli Sager, a Los Angeles-based lawyer with the firm Davis Wright Tremaine, which appealed Karlton’s order on behalf of The Times.